Provider Demographics
NPI:1003898818
Name:QUINTERO NORIEGA, AIDA L (MD)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:L
Last Name:QUINTERO NORIEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 AVE DE LA CONSTITUCION
Mailing Address - Street 2:APT 8E
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-2307
Mailing Address - Country:US
Mailing Address - Phone:787-725-2562
Mailing Address - Fax:
Practice Address - Street 1:E29 CALLE HERNANDEZ CARRION
Practice Address - Street 2:URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4622
Practice Address - Country:US
Practice Address - Phone:787-854-0740
Practice Address - Fax:787-854-8143
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9592207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
067525OtherCRUZ AZUL
067525OtherCRUZ AZUL
E43973Medicare UPIN